高血压患者脉压与左心室肥厚构型及心功能的关系

Relationship between pulse pressure and patterns of left ventricular hypertrophy and cardiac function in hypertensive patients.

目的 探讨药物规则治疗下高血压病 (EH)患者的脉压 (PP)与左心室肥厚 (L VH)构型及心功能的关系。方法 本研究回顾性分析 176例有或无 L VH的 EH患者的 PP与 L VH构型及心功能的相关性。结果 1不对称性室间隔肥厚 (ASH)、对称性室间隔肥厚 (CH)及扩张性肥厚 (DH)三型肥厚组的 PP与无 L VH组相比 ,有明显的差别 ,CH和 DH组较大 (P均 <0 .0 1) ,尤以 DH组较甚。2随着 PP增大 ,左心室收缩及舒张功能均明显的降低。3L ogistic回归分析显示 ,PP与 EH患者左心功能不全发生存在明显的相关性 ,PP每增加 10 m m Hg,左心功能不全增加 30 % (95 % CI:1.2 3～ 1.37,P<0 .0 0 0 1) ;在对年龄和 EH病程进行校正后 ,PP每增加 10 m m Hg显示增加左心功能不全发生率 19% (95 % CI:1.13～ 1.2 5 ,P<0 .0 0 0 1)。结论 在药物规则治疗的 EH患者中 ,PP与 L VH构型具有一定的联系 ,PP是左心功能不全发生的一个重要和独立的相关因素 ;且随着 PP增大 ,左心室收缩及舒张功能均明显的降低。

Objective To investigate the relationship between pulse pressure(PP) and patterns of left ventricular hypertrophy and cardiac function in hypertensive patients. Methods Parameters of blood pressure, clinical features, radionuclide ventriculographic and echocardiographic findings were analyzed retrospectively in 176 patients with essential hypertension. Results ①three types of hypertrophy have a positive correlation with pulse pressure.And the dilated hypertrophy has the higher pulse pressure(P<0.01). ②The cardiac systolic and diastolic functions were decreasing with PP raising.③Logistic regression analysis showed that PP was strongly correlated with left cardiac dysfunction in essential hypertensive patients.After adjusting for age and duration of hypertention,every 10 mmHg increment in PP was associated with 19% increase in left cardiac dysfunction risk(95%CI:13% to 25%,P< 0.001).Conclusion The pulse pressure has a positive correlation with patterns of left ventricular hypertrophy and may be an independent and important risk factor for left cardiac dysfunction in essential hypertensive patients under standard antihypertentive therapy. The cardiac systolic and diastolic functions were decreasing with PP raising.